On February 23, the World Health Organization (WHO) published a survey1 on the two most common psychiatric illnesses affecting the world population: depressive and anxiety disorders. According to this survey, Brazil leads the world in prevalence of anxiety disorders and ranks fifth in depression rates.
Surveys of this kind are highly relevant, as they are often the basis of actions by the government and society and serve as guides for public policy-making for prevention and/or treatment. Whatever the use and attention that the data from this survey might have in the future, some reflections seem timely for an informed debate on this topic.
Compared to the preceding survey, released in 2005,2 the latest WHO report describes an increase in the frequency of both depressive and anxiety disorders worldwide, pointing to population growth and increased longevity as contributing factors for the current picture. Although the latter factors are always involved in discussions about the prevalence of any disease, other potential confounders must be taken into account in this debate, including methodological discrepancies in diagnosis and data recording across countries, cultural differences in help-seeking behaviors, and differential availability and organization of mental health services, to name a few.
In 2007, the British Medical Journal invited two eminent researchers to answer the question “Is depression overdiagnosed?” in their section “Head to Head.” Advocating that depression is overdiagnosed as a result of the medicalization of sadness, Parker3 stated that “a low threshold for diagnosing clinical depression […] risks normal human emotional states being treated as illness, challenging the model's credibility and risking inappropriate management.” In the opposite direction, Hickie4 wrote at the time that “From a health and economic perspective, we can give a clear answer – more adults are alive and well, and we can easily afford to treat more.” Both authors supported their views with solid evidence.
Whatever the precise extent of the problem in Brazil and around the globe, it is already a collective issue, and the personal and financial burden of anxiety and depression demands prompt and coordinated action from the scientific community and government agencies.
In order to answer some of the questions raised by the WHO reports on mental health, research efforts should be directed to three main targets: 1) furthering our understanding of the etiological factors of anxiety and depressive disorders; 2) elucidating their social, cultural, and geographic determinants and impacts; and 3) increasing diagnostic and therapeutic accuracy. If the spread of these disorders is not checked – whether through preventative or therapeutic action – and the needs of affected individuals are not met, the productivity and social-security systems of many countries could be seriously jeopardized in the near future.
Disclosure
The authors report no conflict of interest.
References
- 1.World health Organization (WHO). Depression and other common mental disorders: Global Health Estimates. [Internet]. 2017 [cited 2017 Jun 16]. www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/ [Google Scholar]
- 2.World Health Organization (WHO). Mental Health Atlas 2005 [Internet]. 2005 [cited 2017 Jun 16]. www.who.int/mental_health/evidence/mhatlas05/en/ [Google Scholar]
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- 4.Hickie I. Is depression overdiagnosed? No. BMJ. 2007;335:329. doi: 10.1136/bmj.39268.497350.AD. [DOI] [PMC free article] [PubMed] [Google Scholar]